It is commonly believed that acne is a problem for teenagers, and as we age, acne will gradually disappear. However, many women are troubled by recurring acne from adolescence into adulthood. Have you ever tried various skincare products and medications, but acne still comes and goes?
Perhaps, the problem is not only on the skin but also related to your endocrine system, such as Polycystic Ovary Syndrome (PCOS). Today, let’s talk about how PCOS becomes the “mastermind” behind acne.
What is Polycystic Ovary Syndrome (PCOS)?
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting approximately 5-15% of women of reproductive age worldwide. PCOS affects not only a woman’s ovaries but also involves multiple body systems, including metabolism and the endocrine system.
Its most typical characteristics include:
● Menstrual irregularities;
● Ovulatory disorders;
● High androgen levels;
● Insulin resistance.
How does PCOS cause acne?
One of the reasons acne is closely related to PCOS is the “high androgen levels” in the body. Androgens are not only male hormones but are also present in small amounts in females, primarily produced by the ovaries, adrenal glands, and sebaceous glands, helping to regulate skin oil secretion and hair growth.
When suffering from PCOS, the ovaries produce higher levels of androgens (testosterone and androstenedione). Androgens can cause the sebaceous glands in the skin to secrete more oil and slow down the skin’s renewal rate, making it easier for oil to clog pores, leading to acne.
In addition, “insulin resistance” is another reason for the worsening of acne in PCOS patients. Insulin resistance not only leads to weight gain but also further aggravates the secretion of androgens in the body, induces the proliferation and differentiation of keratinocytes, forming a vicious cycle that further promotes the occurrence and exacerbation of acne.
What is the difference between acne caused by PCOS and other acne?
PCOS-induced acne and other acne?
PCOS acne is a type of hormonal acne, which may be more severe than other types of acne, potentially larger, deeper, or slower to heal, and worsens before menstruation:
● Located deep in the skin, such as cystic acne;
● Located in lower positions on the face (the middle and lower 1/3), such as the chin, jawline, or lower cheeks;
● Red and swollen (acne papules).
So, if you find acne in these areas and have tried countless treatments, and also pay great attention to skincare, but acne still persists, is not easy to heal or recurs. It may be time to break out of the skincare mindset and seek a doctor’s help for a deeper exploration.
Other skin problems caused by PCOS
If you have PCOS, acne may not be the only skin symptom you might face. Other skin changes associated with PCOS may include:
If you notice brown or black patches on your skin, along with other symptoms of polycystic ovary syndrome, you may have acanthosis nigricans. These patches are usually a result of insulin resistance. At this time, you should seek help from an endocrinologist to determine if there are any abnormalities in blood sugar metabolism or insulin metabolism. If abnormalities are found, regulating metabolic abnormalities can greatly improve the condition of acanthosis nigricans.
Higher androgen levels in PCOS can cause dandruff, a manifestation of seborrheic dermatitis, and can also lead to scalp shedding and itching.
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Hair thinning or hair loss
Higher androgen levels in PCOS patients can also lead to androgenetic alopecia. It can be male pattern, distributed in the frontal, temporal, and occipital areas; or female pattern, distributed on the top of the head. It is usually characterized by thinning and sparseness starting from the temples, gradually extending to the top of the head, but the frontal hairline does not recede.
Hirsutism and hair loss may seem contradictory, but PCOS patients can indeed experience both. High androgen levels in PCOS patients lead to hair loss on the head, but may cause the opposite in other parts of the body, such as the upper lip, jaw, chest, and back (including the areola), lower abdomen (including the peri-umbilical and midline), and inner thighs, where excessive hair growth can occur, and pubic hair may be distributed in a male pattern. Hirsutism does not harm physical health but can cause emotional distress and even lead to social barriers.
How to determine if acne is caused by PCOS?
PCOS is not only related to your skin; it affects all aspects of health. When you repeatedly fail to combat acne and have the following signs, you should consider whether there is PCOS:
01
Menstrual irregularities
If your menstrual cycle is disordered, you haven’t menstruated for several months, or you have bleeding outside of menstruation, this may be a danger signal for PCOS.
If you notice increased hair growth on your face, chest, or back, this may be another danger signal for PCOS. This symptom, known as hirsutism, is another result of elevated androgen levels.
03
Thinning hair on the scalp
PCOS can also lead to thinning hair, characterized by a pattern similar to male baldness.
On a balanced diet, if your weight is easy to gain and seems difficult to control, this also indicates metabolic disorders and may be related to PCOS.
If you have the above findings, you should seek help from a gynecologist. The doctor may use hormone tests and gynecological ultrasounds to diagnose whether there is PCOS.
Comprehensively targeting acne caused by PCOS
Controlling acne caused by PCOS requires fundamentally regulating the endocrine system, combining lifestyle, medication, and skincare measures to achieve long-term management.
Low-sugar diets, low-carbohydrate diets, and high-fiber foods help regulate insulin levels and reduce androgen levels in the body. Increasing intake of fruits, vegetables, whole grains, and foods rich in Omega-3 fatty acids(such as salmon, flax seeds, etc.) can help reduce inflammatory responses.
Regular aerobic exercise and strength training not only help control weight but also improve insulin sensitivity and reduce androgen levels.
02
Pharmacological treatment
Oral contraceptives (Combined oral contraceptives, COCs), such as Diane-35, Marvelon, and Yasmin, can effectively regulate estrogen and androgen levels in the body, helping to alleviate acne and hirsutism symptoms. These drugs suppress androgen secretion from the ovaries and reduce the overactivity of sebaceous glands.
However, not all types of oral contraceptives have the same effect on reducing androgens. Therefore, patients with PCOS should seek help from a gynecologist to assess the risks of medication and determine which drug best meets the needs of patients with PCOS.
Spironolactone, initially used to treat high blood pressure and edema (fluid retention), has a positive effect: it can improve acne. Such drugs can inhibit the effects of androgens, thereby reducing the secretion of skin oil and alleviating acne symptoms.
Spironolactone is safe and reliable in reducing androgens and is often used for people for whom COCs are not effective. It is important to use strict contraception while taking it because it may affect the normal development of the fetus.
For those with significant insulin resistance, doctors may prescribe drugs such as metformin to help improve insulin resistance and thereby reduce androgen levels.
Dermatological specialty treatment;
Dermatologists will treat your acne based on its condition, including topical treatments, oral treatments, and procedural treatments. Topical acne medications can help clear excess oil clogging pores and reduce skin inflammation. Combined with oral medications, the effect is even better.
Tips: Benzoyl peroxide and salicylic acid are effective over-the-counter drugs that can treat mild to moderate acne, and these drugs are generally safe to use during pregnancy.
It is not recommended for pregnant women or women planning to become pregnant to use retinoid drugs, as these drugs can cause fetal malformations.
The skin of PCOS patients is often more sensitive, and it is recommended to:
● Use mild and non-irritating cleansers;
● Avoid over-cleansing and irritating products;
● Do not use scrubs, cleansing particles, or exfoliating skincare products;
● Pay attention to facial hydration;
● Choose skincare products that are oil-free and have good oil control effects;
● Avoid wearing makeup for extended periods.
I hope this article can bring you some help, making you clearer about the endocrine problems that may be hidden behind acne. If you are troubled by acne for a long time and have symptoms such as menstrual irregularities, you might as well consult a doctor to rule out the possibility of PCOS. Early detection and intervention are the keys to having healthy skin and a happy life.
References
1. Epidemiology, phenotype, and genetics of polycystic ovary syndrome in adults, diagnosis, and treatment. Up to date.
2. Treatment of acne vulgaris. Up to date.
3. Chinese Society of Obstetrics and Gynecology, Endocrine and Guideline Expert Group. Polycystic Ovary Syndrome Diagnosis and Treatment Guidelines in China [J]. Chinese Journal of Obstetrics and Gynecology, 2018, 53(1): 2-6.
4. Chinese Medical Doctor Association, Endocrine Metabolism Branch. Polycystic Ovary Syndrome Diagnosis and Treatment Endocrine Expert Consensus [J]. Chinese Journal of Endocrinology and Metabolism, 2018, 34(1): 1-7.
